先天性主动脉二叶瓣畸形合并感染性心内膜炎的病原学特点

摘要

目的:探讨先天性主动脉二叶瓣畸形合并感染性心内膜炎(IE)的病原学特点,以总结抗生素选择的经验.方法:我院自2006年1月至2011年5月收治60例先天性主动脉二叶瓣畸形合并IE患者.入院后连续采血3次进行血培养,分析病原学种类及药物敏感试验结果.均给予抗生素治疗,同时治疗原发病,血培养结果回报前应用万古霉素+阿米卡星；血培养阳性者,根据药物敏感试验选择用药.如抗生素不能控制感染、心功能未见改善,施行急诊手术.结果:术前血培养及术中赘生物细菌培养总阳性率33.4％.感染病原菌:草绿色链球菌7例(35％)、金黄色葡萄球菌5例(25％)、肠球菌2例(10％),口腔链球菌、微球菌、表皮葡萄球菌、肠杆菌、铜绿假单孢菌及布氏杆菌各1例(5％).本组药物敏感试验示头孢哌酮-舒巴坦钠敏感11例(55％),万古霉素敏感17例(85％),阿米卡星敏感10例(50％),万古霉素+阿米卡星联合用药的敏感20例(100％).结论:先天性主动脉二叶瓣畸形合并IE病原体菌种呈现分散化、复杂化趋势.积极加强对IE患者的血培养检查和药敏试验极为重要.无药敏结果的情况下,联合应用万古霉素+阿米卡星可收到较好的疗效.%Objective:To guide the selection of antibiotics in infective endocarditis (IE) with congenital bicuspid aortic valve malformation by analyzing the pathogenic microorganisms. Methods: Sixty patients with IE with congenital bicuspid aortic valve malformation during January of 2006 to May of 2009 were studied and blood culture was tested to analyze the pathogenic species and antibiotic sensitive test. All patients were given antibiotic treatment, and given treatment of primary disease. If the blood culture results did not return, vanco-mycin and amikacin were used. If blood culturewas positive, we selected drugs according to drug sensitivity test. If such antibiotics could not control the infection, cardiac function had not improved, the implementation of emergency surgery were needed. Results: Preoperative blood culture and intraoperative vegetation bacterial culture positive rate was 33. 4%. Pathogenic bacteria of our cases were viridans in 7 cases (35% ) , staphylo-coccus aureus in 5 cases (25% ) , enterococcus in 2 cases (10% ) , oral streptococci, micrococcus, staphylo-coccus epidermidis, enterobacter, pseudomonas aeruginosa, brucella bacteria in one case (5% ). The group of drug sensitivity tests showed cefoperazone and sulbactam sodium were sensitive in 11 cases (55% ) , vancomy-cin in 17 patients (85% ) , amikacin in 10 patients (50% ) , vancomycin and amikacin combination of sensitivity in 20 cases (100% ). Conclusion: The pathogenic organisms present disperse and complication in IE with congenital bicuspid aortic valve malformation, it is vital important to take the intensive blood culture and antibiotic sensitive test. If there were no positive results of drug susceptibility, the combination of vancomycin and amikacin would accept better treatment results.